The US Department of Health andHuman Services (HHS) is movingfull steam ahead with the adoptionof electronic prescribing (e-prescribing)and electronic health records (EHRs).The Centers for Medicare and MedicaidServices and HHS recently proposedrules that represent a unified effort tomove forward with the goal of enhancingthe health care of Medicare beneficiariesand all Americans. The proposals willaccelerate the adoption of health informationtechnologies by hospitals, physicians,and other health care providers toimprove quality and safety for patients.
Rolling out total EHRs can take yearsfor many organizations.Many health caresectors are moving toward EHRs instages. Aside from a cost factor, the stepwiseapproach allows organizations togradually implement new technologiesat their own pace based on their needs.Allscripts, a provider of clinical software,connectivity, and information solutionsfor physicians, is familiar with this scenario.The company used a modularapproach with its TouchWorks ElectronicHealth Record. The company had a numberof applications previous toTouchWorks. The company launched theTouchWorks solution in 2000. Whenhealth care providers select TouchWorks,they are purchasing a single application.
"In many cases, the trend a couple ofyears ago was to purchase one productat a time to get their feet wet," said DanMichelson, chief marketing officer at thecompany. While TouchWorks can beimplemented with full EHRs, the solutionalso provides health care sectors withthe option of using the modularapproach to allow physicians to initiallyadopt one or a few modules of the totalsolution. Once comfortable, more functionalitiescan be added over time, eventuallyprogressing to full EHRs.
Allscripts has taken its experiencewith EHRs and authored The ElectronicPhysician: Guidelines for Implementing aPaperless Practice. The book discussesthe full gamut of implementing a successfulEHR program.
Studies have shown that e-prescribing,a component of EHRs, is being implementedmore rapidly across thehealth care industry. In many cases,e-prescribing is the first step takentoward full EHRs. As one of the firstproviders to bring e-prescribing to themarket, Larry Trusky, vice president ofproduct development for Allscripts, said,"There has been a lot of momentum inthe industry around e-prescribing. E-prescribinghas been the most popular, but itdoes not mean everyone starts with it."
When working with health careproviders, Allscripts likes to know their"point of pain." "All the groups are differentin what they want. It is not a one-size-fits-all approach. They [physicianpractices] can add on seamlessly withour solution," said Michelson.
George Washington University MedicalFaculty Associates (MFA) knew itssource of pain—too much paper. MFArelied heavily on paper methods forstoring patients' charts, prescribingmedications, tracking laboratory tests,and a variety of everyday activities.The paper-based methods were labor-intensiveand time-consuming.
The physicians practice decided topurchase EHRs. They evaluated 6 leadingsolutions on the market and decidedon TouchWorks. Instead of implementingin stages, MFA set a newstandard for rapid EHR implementationby bringing 99 physicians, 130 residentsand interns, and >200 supportstaff live on TouchWorks in less than amonth.
NorthEast Medical Center—a 457-bedmedical center in Concord, NC—hastaken a slower approach in implementingfull EHRs. The medical center hasbeen using Allscripts' e-prescribing solutionfor 3 years, according to KeithMcNeice, vice president and chief informationofficer of the hospital. Currentlyhalf of the center's clinics are using e-prescribing.
McNeice said the main reason fordeciding on the TouchWorks solutionwas its modular capabilities. "The modularapproach gave us the ability tobuild the patient database. We can literallygo physician by physician to seewhat they are comfortable with."
The medical center recently connectedits physicians across 33 locationsusing the TouchWorks ElectronicHealth Record. With the added functionality,physicians have the ability tocommunicate the full patient recordwith everyone in the health care deliveryprocess.
It will probably be another 2 yearsbefore NorthEast Medical Center fullyimplements EHRs, according to McNeice.In the meantime, the medical center isplanning to revisit its clinics already usinge-prescribing and add the remainingTouchWorks functionalities to make theclinics have total EHRs. McNeice saidthey also plan to implement e-prescribinginto the clinics that are not using thistechnology.
Children's Healthcare of Atlanta decided21/2 years ago to move forward with asingle EHR platform. The hospital neededto find a vendor that could provide a pediatric-specific EHR. "We needed a systemthat could configure to meet the needs ofpediatrics," said Ellen Hansen, director ofclinical informatics at the hospital.
The hospital evaluated 4 vendorsbefore selecting the clinical informationsystem Epic. In June 2004, stage 1of the Epic implementation tookeffect. The system provided staff withaccess to clinical results, transcriptions,and patient lists. The pharmacymanagement portion and medicalrecords components were deployed inearly 2005.
The health care system's 2 anchorhospitals began using EpicRx in 2005.Children's at Egleston began on January25, and Children's at Scottish Rite beganon March 16. The application allows thepharmacy to send medication administrationrecords directly to laser printersin each nursing station; schedule medicationtimes; add a medication report tothe inpatient summary activity; as well asother functions to improve the processof dispensing medications. "We nowhave a single pharmacy system acrossour campuses," explained Hansen.
Children's also changed the way itmanaged patients' charts with Epic'sChartMaxx document scanning. Theapplication creates a digital copy of allpaper records for patients at the point ofdischarge. The component allows thestaff to countersign orders and notesfrom any computer in the hospital.
Children's continues to use the paperrecord, however, for the patient until discharge.The application was launched onMarch 22 at Children's at Egleston andApril 12 at Children's at Scottish Rite.Children's continued its transition toEHRs with implementation of Epic's medicationadministration record inNovember 2005. This phase allows staffto enter laboratory, radiology, and physicianorders into the system. Additionally,nurses began using an electronic admissiondatabase, and pharmacy staff startedputting orders into the system. Whilethe implementation will not impact physiciansas heavily, Hansen noted that itmarks the first time clinicians will have toget into Epic.
Overall, the staff has found the moveto the Epic system positive. "They [thestaff] find the system more user-friendlythan our previous system. There aremore verification features, and it hasreduced the number of phone calls" between hospital departments, saidHansen.
Epic's effectiveness will go under amicroscope with a grant to study anddocument the system. The Agency forHealthcare Research and Quality hasawarded a $1.5-million, 3-year grant toChildren's, Georgia Tech, and EmoryUniversity. The study will evaluatepatient quality and safety, human-computerinteraction, education, and job satisfaction.
To help with the transition to EHRs anda paperless environment, Children'srecently implemented 300 mobile workstationsfor patient data capture andaccess at the point of care within its 2anchor hospitals, each with 250 beds.The mobile carts from Flo Healthcare arewireless and battery-operated.
"We chose carts instead of computersbecause PDAs were too small for theamount of data, and tablets and laptopswere too expensive and can be droppedand broken. The carts have a small footprintand give mobility," explainedHansen.
Prior to selecting Flo Healthcare,Children's brought 3 vendors into bothhospitals and had 800 employees andphysicians evaluate the workstations.Children's ultimately chose FloHealthcare because it offered more interms of service. A real bonus was howthe company handled evaluation of itscarts. "We gave them feedback, and theymade changes to their cart based on thefeedback. It was very impressive," commentedHansen.